Sustained Elite Suppression of Replication Competent HIV-1 in a Patient Treated With Rituximab Based Chemotherapy

The mechanism of elite control of HIV-1 replication is not fully understood. While immunosuppression due to rituximab based chemotherapy has been associated with increased replication of HBV, CMV, and HIV-1, control of replication-competent HIV-1 was maintained in an elite controller/suppressor treated with a regimen that included vincristine, cyclophosphamide, prednisone, four rounds of plasmapheresis and ten cycles of rituximab. The data suggests that de-novo antibody responses do not play a significant role in the control of viral replication in these patients. Why this case is important Elite controllers or suppressors (ES) are HIV-1 positive patients who maintain viral loads of < 50 copies/ml without antiretroviral therapy. Studies have shown that while infection with defective HIV-1 can explain elite control in some patients1, other patients are infected with fully replication-competent virus2,3. This finding has strongly suggested that host factors play an important role in some ES. Interestingly rituximab, a monoclonal antibody that depletes B cells, has been linked with the reactivation of latent HBV and CMV infections 4